Effects of Resuscitation and Simulation Team Training on the Outcome of Neonates with Hypoxic-Ischemic Encephalopathy in South Tyrol

Background: /Objectives: Neonatal hypoxic-ischemic encephalopathy (HIE) due to perinatal complications remains an important pathology with a significant burden for neonates, families, and the healthcare system. Resuscitation and simulation team training are key elements in increasing patient safety. In this retrospective cohort study, we evaluated whether regular constant trainings of all personnel working in the delivery rooms in South Tyrol increased the outcome of neonates with HIE. Methods: We retrospectively analyzed three groups of neonates with moderate to severe HIE who required therapeutic hypothermia. The first group included infants before the systematic introduction of trainings and compared it to the second group after three years of regular trainings. A third group after the SARS-CoV-2 pandemics was compared in order to evaluate retention of skills and the long-term effect of our training program. Results: Over the three study periods mortality decreased from 41.2% to 0% and 14.3% respectively. There was also a significant reduction of patients with subclincal seizures detected only in EEG from 47.1% in the first period to 43.7% and 14.3% in the second and third study period respectively. Clinical manifest seizures decreased significantly from 47.1% to 37.5% and 10.7%, as well as severe brain lesions in ultrasound (US) and MRI. Conclusions: Constant and regular simulation training for all birth attendants significantly decreases mortality and improves the outcome in neonates with moderate to severe HIE. This positive effect seems to last even after a one-year period where training sessions could not be performed due to the Covid pandemics.